Anatomic Restoration Technique: A Biomechanics-based Approach for Early Continence Recovery After Minimally Invasive Radical Prostatectomy

Abstract

Despite refinements in surgical technique over the past decade, urinary incontinence following radical prostatectomy remains a frustrating and costly side effect that significantly impairs patients’ quality of life. With the increasing popularity of radical prostatectomy as a firstline treatment for early prostate cancer, and with more patients being diagnosed and treated at a younger age, post prostatectomy incontinence remains a significant issue. Reported risk factors include increasing patient age, bladder dysfunction before surgery, previous transurethral resection of the prostate for obstructive symptoms, anastomotic stricture, surgical technique, and surgeon experience. 1,2 Beginning in 2006, our group has made stepwise progress in overcoming this problem through technical innovations borne from study of real-time intraoperative video and cadaveric anatomy, histopathologic analysis of final prostatectomy specimens, and data analysis of functional outcomes. 3-7 We have developed a paradigm of 7 key principles based on possible biomechanical forces acting on the urethral rhabdosphincter and newly fashioned anastomosis that we believe will hasten early con